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Informed Consent: An Overview

Understanding the concept of informed consent, and what the term means to patients as well as dental professionals, is critical in contemporary dental care.  As outlined below, informed consent should be formalized in order to more effectively educate patients about their own care, drive compliance with a suggested treatment plan, and provide important risk management benefits.

Informed Consent as the Patient’s Right

Public policy and court rulings have continuously affirmed that patients have the right to make decisions about their healthcare.  Each patient is a full partner in his or her healthcare team and, as such, is entitled to participate in discussions about planning and implementation of any kind of proposed treatment or procedure.  At a minimum, the informed consent process includes: 

  1. An update on the patient’s current health status, including a diagnosis.  This discussion ensures that the patient receives the results of tests or exams and can ask questions and voice concerns. 
  2. Review of treatment options.  Patients cannot make good treatment decisions unless they know their options.  Too often, options are presented from the perspective of the patient’s presumed financial standing without taking in to account the patient’s preferences and values.  If a treatment option is within an acceptable standard of care, it should be presented to the patient.
  3. Risks and benefits associated with each treatment option.  These vary depending on the proposed treatment.  If there are two acceptable treatment options for a dental condition, then both of these options should be discussed with the patient.  Information to be shared should include: a) the presumed benefits of each treatment; b) the possible minor complications or risks that most commonly occur with each procedure; c) the potentially significant but rare complications; d) the variance in treatment plans, e.g., Option A may involve more visits and/or more physical discomfort than Option B; d) ranges of cost for each option; e) the risks associated with electing not to have any treatment at all--a process known as informed refusal. 
  4. Documentation of the responses to the patient’s questions as well as documentation of the patient’s agreement to comply with a specific treatment plan.  Documentation of consent without incorporation of the previous three steps may not comprise a valid agreement. 

Informed Consent as the Doctor’s Duty 

It is the dentist’s non-delegable duty to obtain a patient’s consent.  Only the dentist has sufficient knowledge of the patient and his or her condition, to be able to advise the patient and address any questions or concerns. 

Research has shown that patients who feel informed and empowered report greater satisfaction with their healthcare outcomes.  Therefore, it is to the dentist’s distinct advantage to use the educational and partnering aspects of informed consent to engage the patient. 

This same research has also shown that patients who have been warned about possible complications are less likely to be surprised and distrustful if a known complication does occur.  This retention of good will gives the dentist the opportunity to continue to work with the patient to obtain a satisfactory outcome. 

Documentation of informed consent serves as a clinical reminder for the dental team but it has significant liability reduction benefits as well.  The existence of a written consent may remind a patient of aspects of the treatment plan that he or she had forgotten.  The existence of a valid consent will make it more difficult for a dissatisfied patient to allege that he or she was the victim of negligent care. 


The use of a formalized informed consent process provides many benefits to the dental team as well as to the patient.  It can help the patient be a better-informed and more proactive partner in his or her own care.  It can reinforce each partner’s commitment to the treatment plan.  It can help identify areas of misunderstanding or non-compliance and serve as a framework for keeping the treatment plan on track.  Finally, it can verify the professional care and concern implemented by the dentist on the patient’s behalf--a significant risk management benefit if the patient is ultimately dissatisfied with the dental care provided.

*Ms. Roman is Risk Management Education Leader, Medical Protective, Indianapolis, IN.

Related Reading  
  1. Bodenheimer T, Lorig K, Holman H, et al.  Patient self management of chronic disease in primary care.  JAMA 2002;288(19);2469-2475. 
  1. Glasgow RE, Funnell MM, Bonomi AE, et al.  Self-management aspects of the improving chronic illness care breakthrough series:  Implementation with diabetes and heart failure teams.  Ann Behav Med 2002;24(2):80-87.
  1. Heisler M.  Building Peer Support Programs to manage Chronic Disease:  Seven Models for Success.  California Health Care Foundation.  December 2006. Available at:  http://wwwchet.org/topics/chronicdisease/index.cfm?itemID=127997
  1. Lewin SA, Sken ZC, Entwistle V, et al.  Interventions for providers to promote a patient-centered approach in clinical consultations.  Cochrane Database Syst Rev 2001:CD003267.
  1. Lorig KR, Sobel DS, Stewart AL, et al.  Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalizations:  A randomized trial.  Med Care 1999;37(1):5-14.
  1. Fenders CM, Valk GD, Griffin S, et al. Interventions to improve the management of diabetes mellitus in primary care, outpatient, and community settings.  Cochrane Database Syst Rev  2001;1:CD001481.
  1. Schillinger C, Osborn R, Huynh PT, et al.  Closing the loop:  Physician communication with diabetic patients who have low health literacy.  Arch Intern Med 2003;163(1):83-90.
  1. Suchmen AL, Roter D, Green J, Jr. Physician satisfaction with primary care office visit.  Collaborative Study Group of the American Academy of Physicians and Patients.  Med Care 1993;31(12):1083-1092.

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